Facing Rising Health Costs, Massachusetts Seeks Cost Cutting That Improves Care - Solman, The News Hour
GWEN IFILL: Much of the anger and debate surrounding the Affordable Care Act focuses on questions of coverage and individual costs for the consumer. But another big question is whether it can hold down overall costs, as intended.
The state of Massachusetts is now grappling with that very question, something it didn't do when lawmakers first expanded coverage there.
NewsHour economics correspondent Paul Solman has the story, part of his continuing reporting Making Sense of financial news.
MAN: The task of access to affordable health care is not complete.
PAUL SOLMAN: A meeting of the Greater Boston Interfaith Organization, which plumped for the 2006 state law on which the Affordable Care Act is modeled. It's led to nearly universal coverage in Massachusetts, but it didn't address costs. That's the next challenge.
MAN: We're worried for the future.
Kathleen Wells Show - KCAA - San Bernardino, California
Guest: Philip Caper, M.D., on the Affordable Care Act
http://kcaaradio.celestrion.net/kcaa-podcasts/wells/20131120.html
By JONATHAN WEISMAN and SHERYL GAY STOLBERG
WASHINGTON — The memo distributed to House Republicans this week was concise and blunt, listing talking points and marching orders: “Because of Obamacare, I Lost My Insurance.” “Obamacare Increases Health Care Costs.” “The Exchanges May Not Be Secure, Putting Personal Information at Risk.” “Continue Collecting Constituent Stories.”
The document, the product of a series of closed-door strategy sessions that began in mid-October, is part of an increasingly organized Republican attack on the Affordable Care Act, President Obama’s signature legislative initiative. Republican strategists say that over the next several months, they intend to keep Democrats on their heels through a multilayered, sequenced assault.
The idea is to gather stories of people affected by the health care law — through social media, letters from constituents, or meetings during visits back home — and use them to open a line of attack, keep it going until it enters the public discourse and forces a response, then quickly pivot to the next topic.
For a House more used to disarray than methodical game plans, the success so far has been something of a surprise, even to the campaign’s organizers.
“Yeah, there is a method being followed here,” said Representative Michael C. Burgess, a Texas Republican involved in the effort, “but, really, these stories are creating themselves.”
First it was the malfunctioning website, HealthCare.gov, then millions of insurance policy cancellation notices sent to individuals with plans that did not meet the requirements of the health law. Earlier this week, the House aired allegations that personal data is insecure on the Internet-based insurance exchanges.
At a congressional field hearing set for Friday in Gastonia, N.C., the line of attack will shift to rate shocks expected to jolt the insurance markets in the next two years. Coming soon: a push to highlight people losing access to their longtime physicians and changes in Medicare Advantage programs for older people.
The effort has its roots in a strategy developed last spring, when House Republican leaders — plagued by party divisions that were thwarting legislative accomplishments — refocused the House’s committees on oversight rather than on the development of new policies.
Rob Borden, a general counsel to Representative Darrell Issa of California, the chairman of the House Committee on Oversight and Government Reform, moved to a newly created position that reported jointly to Speaker John A. Boehner and Representative Eric Cantor of Virginia, the majority leader. Mr. Borden’s task was to coordinate and monitor oversight activities across separate committees to make sure they are not overlapping or undercutting one another.
Applicants Find Health Website Is Improving, but Not Fast Enough
By ABBY GOODNOUGH
DOYLESTOWN, Pa. — Tilda Elias had reason to be optimistic when she opened the HealthCare.gov website on Monday, ready to help her first client of the week find health insurance. Technicians had made fixes to the online insurance exchange over the weekend. Even more promising, her client, Giovanna Romano, had managed to complete an online application at home with no problems.
But after Ms. Romano logged in, the system made her reconfirm everything in her application, a process that dragged on for 40 minutes. Then came the screen message that tens of thousands of people shopping for insurance under President Obama’s new health care law have come to hate: “Sorry, our system is temporarily down.”
Defeated, Ms. Elias, a “navigator” who helps people sign up for coverage, scheduled another appointment with Ms. Romano, a busy home health worker who could not return until December. “I’m not sure what happened here,” Ms. Elias told her, shaking her head.
Despite weeks of work by a small army of software experts to salvage HealthCare.gov, navigators in states that depend on the federal insurance exchange say they still cannot get most of their clients through the online enrollment process.
Those navigators said they had seen improvements in the system since its disastrous rollout on Oct. 1, particularly in the initial steps of the application process. But the closer people come to signing up for a plan, the more the system seems to freeze or fail, many navigators said.
Administration officials say technicians have made significant improvements to sections that allow consumers to apply for insurance and compare health plans, and Mr. Obama this week encouraged people to continue trying to use the exchange. But those officials acknowledge that parts of the system are still not performing as well as they had hoped. And in congressional testimony on Tuesday, Henry Chao, the chief digital architect of the federal online marketplace said that 30 percent to 40 percent of the project was still being built.
At Community Action of Nebraska, a nonprofit group with a statewide network of navigators, Roger Furrer has witnessed the problems up close. Most applicants he worked this week could not get to the screen that shows their coverage options. “That’s really problematic,” he said, “because if people are wavering already, they won’t always come back and follow through.”
Insurers restricting choice of doctors and hospitals to keep costs down
By Sandhya Somashekhar and Ariana Eunjung Cha,
As Americans have begun shopping for health plans on the insurance exchanges, they are discovering that insurers are restricting their choice of doctors and hospitals in order to keep costs low, and that many of the plans exclude top-rated hospitals.The Obama administration made it a priority to keep down the cost of insurance on the exchanges, the online marketplaces that are central to the Affordable Care Act. But one way that insurers have been able to offer lower rates is by creating networks that are far smaller than what most Americans are accustomed to.
The decisions have provoked a backlash. In one closely watched case, Seattle Children’s Hospital has filed suit against Washington’s insurance commissioner after a number of insurers kept it out of their provider networks. “It is unprecedented in our market to have major insurance plans exclude Seattle Children’s,” said Sandy Melzer, senior vice president.
The result, some argue, is a two-tiered system of health care: Many of the people who buy health plans on the exchanges have fewer hospitals and doctors to choose from than those with coverage through their employers.
A number of the nation’s top hospitals — including the Mayo Clinic in Minnesota, Cedars-Sinai in Los Angeles, and children’s hospitals in Seattle, Houston and St. Louis — are cut out of most plans sold on the exchange.
In most cases, the decision was about the cost of care.
In Seattle, the region’s predominant insurer, Premera Blue Cross, decided not to include the children’s hospital as an in-
network provider except in cases where the service sought cannot be obtained anywhere else. “Children’s non-unique services were too expensive given the goal of providing affordable coverage for consumers,” spokesman Eric Earling said in an e-mail.
For example, a pediatric appendectomy at Children’s costs about $23,000, he said. At another community hospital, the cost is closer to $14,100. Melzer said his hospital often bills more than community hospitals for comparable procedures because the children it treats are often gravely ill, so even a routine tonsillectomy may be more complicated.
But as a result, families like Jeffrey Blank’s, which has relied on Seattle Children’s since his daughter, Zoe, received a diagnosis of a rare bone disorder, face difficult decisions. Under some of the new law’s health plans, the family would no longer be able to take Zoe to Children’s for her routine checkups, or it could count as an “out-of-
network” visit, saddling the family with huge bills.
“It just stresses me,” said Blank, 53, a self-employed massage therapist who is sorting through his options but readily admits that his family has benefited from other parts of the health law. “I hope things continue wonderfully for my daughter and that she doesn’t need the level of care she got after her diagnosis, but there’s this unknown.”
In New Hampshire, Frisbie Memorial Hospital took legal action against an insurer that excluded it from its marketplace plans, and in Missouri, consumer advocates successfully lobbied an insurer to add a children’s hospital after it unveiled a plan that lacked one.
Experts say that routine care offered at cheaper, community-based hospitals is often comparable to that of pricey academic medical centers.
http://www.washingtonpost.com/national/health-science/insurers-restricting-choice-of-doctors-and-hospitals-to-keep-costs-down/2013/11/20/98c84e20-4bb4-11e3-ac54-aa84301ced81_print.html
Maine small businesses wrestling with health law
Some have their policies canceled or rush to renew early amid the confusion, but lower costs will come, a federal official says.
WASHINGTON — Small businesses across Maine are renewing their health insurance policies months early rather than buying new plans that comply with the Affordable Care Act, reflecting confusion and uncertainty about the effects of the federal law.
Anthem Blue Cross Blue Shield, Maine’s largest insurer, says it is getting a “very sizable percentage” of renewals that will take effect before new coverage mandates begin Jan. 1. Insurance brokers also report strong interest among businesses that want to renew before year’s end.
Some businesses are renewing early to delay what will likely be higher premiums under the health care law. Others simply want more time to consider their options.
“We find people are still on the steep end of the learning curve as far as the Affordable Care Act and what their choices are,” said David Clough, Maine director of the National Federation of Independent Businesses.
For weeks, headlines have blared about the millions of Americans who have received cancellation notices from their insurers because their policies won’t meet minimum coverage standards under the Affordable Care Act.
Robert Neveu is in the less publicized but sizable group of business owners who got cancellation notices for insurance bought for employees on the “small group market” and are now struggling to navigate the new system.
Neveu, who runs the Portland-based software company Certify LLC, summed up his experience in the past 30 days with two words: frustration and confusion.
Our View: MaineCare study won’t tell much we don’t know
A $1 million review of state programs is more likely to delay real action than facilitate it.
The Alexander Group’s report on Maine’s social service system isn’t due until May 15, but there’s not much mystery to what it will contain.
Gary Alexander, the firm’s principal partner, has a long track record as an ideological warrior in the fight to cut social service budgets, first as state welfare director in Rhode Island and Pennsylvania, and more recently as a consultant, completing a similar study to the one Maine has ordered for the state of Arkansas.
In every state, his prescription has been the same: eliminate coverage and services, beef up fraud investigations and ask the federal government for relief from Medicaid rules.
Since that more or less describes the LePage administration’s agenda since taking office, it’s hard to see why the taxpayers should have to shell out $925,000 to hear the same thing from someone else.
The administration lumps all social programs together and calls them “welfare,” making it sound as if tax money is being used to pay people not to work. The real picture is more complicated.
The annual DHHS budget is $3.4 billion, but most of it, $2.4 billion in state and federal funds, pays for the Medicaid program, known here as MaineCare. In 2010, 72 percent of MaineCare recipients were either elderly, disabled or children. The remaining 28 percent were adults, many of whom have jobs.
Cutting their health insurance won’t make most MaineCare clients more independent. It will just make them sicker. The state has already made it harder for Mainers to get coverage under MaineCare, particularly for parents of eligible children and childless adults, which the governor says will preserve the programs for the “truly needy.” But relatively little of the MaineCare budget is spent on the population he wants to cut.
According to a study by the Muskie School of Public Service, adults make up 28 percent of the program’s roster but account for only 10 percent of the costs. People with disabilities make up 20 percent of the program enrollees but account for 49 percent of the cost.
Cutting non-disabled adults from the program might be good politics, but it doesn’t do much to lower costs and creates expenses elsewhere in the health care system when the uninsured put off getting care.
Troubled broker for MaineCare rides program never bought required bond
DHHS and the company won’t say why, but the omission could potentially be costly for the state. ‘This was gross mismanagement,’ one lawmaker says.
The Connecticut company under fire for its work as a contractor for MaineCare’s medical transportation program failed to obtain a performance bond, as required by its contract with the Maine Department of Health and Human Services.
Coordinated Transportation Solutions has prompted complaints from thousands of MaineCare patients, who have missed appointments or been stranded because the company has failed to schedule rides for them to doctors’ offices, therapists and other health care providers. The DHHS threatened in October to cancel the company’s $28.3 million, one-year contract. State officials also said the company’s performance bond could be revoked, which would cost the contractor money and help Maine recover funds to improve the program.
But there is no bond to revoke, because Coordinated Transportation Solutions failed to purchase one, a DHHS spokesman said Wednesday.
How healthy are nuts? Eat, and live longer
The largest study ever done on their impact on mortality suggests a few handfuls daily can slash the risk of fatal diseases.
By Marilynn Marchione
The Associated Press
The Associated Press
DALLAS — Help yourself to some nuts this holiday season: Regular nut eaters were less likely to die of cancer or heart disease – in fact, were less likely to die of any cause – during a 30-year Harvard study.
Nuts have long been called heart-healthy, and the study is the largest ever done on whether eating them affects mortality.
Researchers tracked 119,000 men and women and found that those who ate nuts roughly every day were 20 percent less likely to die during the study period than those who never ate nuts. Eating nuts less often lowered the death risk too, in direct proportion to consumption.
The risk of dying of heart disease dropped 29 percent and the risk of dying of cancer fell 11 percent among those who had nuts seven or more times a week compared with people who never ate them.
The benefits were seen from peanuts as well as from pistachios, almonds, walnuts and other tree nuts. The researchers did not look at how the nuts were prepared – oiled or salted, raw or roasted.
A bonus: Nut eaters stayed slimmer.
“There’s a general perception that if you eat more nuts you’re going to get fat. Our results show the opposite,” said Dr. Ying Bao of Harvard-affiliated Brigham and Women’s Hospital in Boston.
She led the study, published in Thursday’s New England Journal of Medicine. The National Institutes of Health and the International Tree Nut Council Nutrition Research & Education Foundation sponsored the study, but the nut group had no role in designing it or reporting the results.
Democrats in Legislature rip LePage’s choice to study Maine welfare programs
Posted Nov. 21, 2013, at 8:56 a.m.
AUGUSTA, Maine — Key state lawmakers, including a Lewiston senator, are questioning a nearly $1 million contract to hire a consultant to study an expansion of Medicaid in Maine.
Lawmakers also are questioning the consulting firm’s objectivity and why Department of Health and Human Services officials in Republican Gov. Paul LePage’s administration awarded the no-bid contract under the radar of the Legislature.
“I would like to know where they are finding a million dollars,” said state Sen. Margaret Craven, D-Lewiston. “I would also like to know why the governor did not hire a consultant to help with Riverview (Psychiatric Center), or a consultant to help with the non-emergency transportation (program). They are two major money-wasters, and debacles that the governor does not seem to be concerned with.”
Craven is Senate chairwoman of the Legislature’s Health and Human Services Committee. Her reference to Riverview and the ride program are two other issues the Legislature and DHHS are dealing with.
Riverview, the state’s forensic psychiatric hospital, faces a loss of nearly $20 million in federal funding while the $40-million nonemergency rides program has been in turmoil since the state hired three private-sector brokers to administer the rides.
“I truly have smoke coming out of my ears about this,” Craven said Wednesday. “It makes no rhyme or reason to me, and this particular consultant, for one thing, he is a carbon copy of the governor’s philosophy.”
Adrienne Bennett, LePage’s press secretary, said outrage from Democrats in the Legislature is misplaced, given that many departments in state government, including the Legislature, regularly contract for studies. She noted a recent $450,000 study contracted by the Legislature’s Education Committee in 2012.
“It’s nothing that’s out of the ordinary,” Bennett said.
She said lawmakers were wrong to leap to conclusions about what the study would recommend before it was complete. “It’s not partisan and we don’t know what it’s going to say, given it’s not even out yet,” Bennett said.
Still others questioned why the contract, signed in September, was only this week brought to the public’s attention and why state lawmakers were not told of the study before November.
“You know we’ve been in meetings with (the Appropriations and Financial Affairs and Health and Human Services committees) and nobody in the administration has said anything about this $1 million contract,” said state Rep. Peggy Rotundo, D-Lewiston. Rotundo is House chairwoman of the Legislature’s budget-writing Appropriations and Financial Affairs Committee.
Obamacare tradeoffs: Now they tell us …
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| President Barack Obama is suffering the worst season of his presidency because people are mad that critical parts of the Affordable Care Act are not working the way they are supposed to work. The larger longer-term threat to his signature legislative achievement — and to his presidency generally — is different. It is the growing backlash over Obamacare working precisely the way it is supposed to work. The broken HealthCare.gov website, while an excruciating embarrassment, is on the path to repair. If Amazon and the airlines can manage millions of transactions a day over the Web with ease, say experts, the federal government’s class of slow students surely will solve the problem in due course. (Understanding Obamacare: POLITICO’s guide to the ACA) But the problem with Obamacare’s stumbling start is that it shined a harsh light on intendedconsequences — more costs and more government regulation — that were always embedded in the ACA but were deliberately downplayed by Obama and Democrats on the way to passage. Backers hoped the costs of the ACA and its roster of losers would remain obscured after launch in a rush of good feeling about the law’s benefits and its roster of winners. This rush of good feeling, to put it mildly, hasn’t yet materialized. But some very clear tradeoffs that were always central to Obamacare have been put on sharp display. *It is, in many respects, a classic social welfare program. Like other social programs, it involves transferring from haves to have-nots. Healthy people are going to have to pay to help sick people get coverage. People who had skimpy coverage before — and in some cases, not-so-skimpy coverage — will have to upgrade to insurance that covers more things, but costs more. And young people will have to pay so older people don’t face sky-high premiums. (PHOTOS: 10 Sebelius quotes about Obamacare website) *For some people, the policy changes were always going to be highly disruptive. To rebuild the broken individual health insurance market, the part of the market that has always been riddled with holes, the law eventually has to move people with individual coverage into new plans with stronger rules and benefits. Whether it happens now or later, it has to happen — otherwise the new market falls apart. |
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